[Form No.4]

Report of adoption ( Day Month Year)	※ Please write after reading the guidelines on the back and, when required to select one option, please circle the number as follows "○".
Section	Adoptive father	Adoptive mother
① Adoptive parents	Name	Korean or English		Place of family origin (Chinese characters)		Korean or English		Place of family origin (Chinese characters)
Chinese characters		Date of birth		Chinese characters		Date of birth
Resident Registration No.	-	Resident Registration No.	-
Permanent domicile address
Address
② Adopted child	Name	Korean or English		Place of family origin (Chinese characters)		Resident Registration No.	-
Chinese characters		Sex	ꊱ Male ꊲ Female	Date of birth
Permanent domicile address
Address
③ Real biological parents of adopted child	Father	Name		Permanent domicile address
Resident Registration No.	-
Mother	Name		Permanent domicile address
Resident Registration No.	-
④ Other
⑤Witness	Name	Seal or signature	Resident Registration No.	-
Address
Name	Seal or signature	Resident Registration No.	-
Address
⑥Assentient	Father	Name	Seal or signature
Mother	Name	Seal or signature
Lineal ascendant	Seal or signature	Resident Registration No.	-	Relationship	Adopted child's.......
Spouse of adopted child	Seal or signature	Resident Registration No.	-
Guardian	Seal or signature	Resident Registration No.	-	Court of permission		Date of permission
⑦Declarer	Adoptive father	Seal or signature	Tel. No.
E-mail address
Adoptive mother	Seal or signature	Tel. No.
E-mail address
Adopted child	Seal or signature	Tel. No.
E-mail address
Legal representative	ꊱ Parents	Father	Seal or signature	Tel. No.
E-mail address
Mother	Seal or signature	Tel. No.
E-mail address
ꊲ Guardian	Seal or signature	Tel. No.
E-mail address
Permission of adoption if aged under 15	Court of permission		Date of permission
⑧Submitter	Name		Resident Registration No.	-

Written method
※ If real biological parents, adoptive parents or adoptive child are foreigner, please write the nationality on section of the permanent domicile address. No. ① and No. ② : If you wrote the resident register No. on section of the resident register No., can omit to write the date of birth in accordance with article 25. section 2 of the law. No. ④ : Please write below items and especially necessary informations for clarifying the family relation register. - If legal representative of adoptive child(Less than full fifteen years old) or guardian who is approved by family court permitted the adoption and reported in place of him, please write the reason. - In accordance with Article 8. section 1.「Exemption law for promotion and procedure of adoption」 if surname and place of family origin of adoptive child follow as surname and place of family origin of adoptive parents by demand of adoptive parents, please write about that. No. ⑥ : Please write like below on section of assentient. - The person who will be adopted, must receive the agreement from parents (but, if the parents was registered on family relation register who was lost by judgment the parental authority about him, the parents can't agree), if the parents can't agree by death or other reasons, must receive from the nearest and the eldest ascendant of the other lineal ascendant. - The person who will be adopted, if he is minor and if he hasn't anyone of above mentioned parents or lineal ascendant, must receive the agreement from the guardian who is permitted by family court. - Instead approval person of adoption don't have to write on section of assentient. - If person who has a spouse is to be adoptive child, must receive the agreement from the other person. - When an incompetent adopt or is adopted, must receive the agreement from guardian. No. ⑦ : Person to be adopted seal and signature(or sign) on section of adoptive child, but if he is under 15 years old, don't write on section of adoptive child and legal representative(the guardian who is permitted by family court, write name of permission court and permission date) seal and signature (or sign) after marking as “○” on relevant item number . : If you repot the adoption in accordance with 「Exemption law for promotion and procedure of adoption」, person to be adoptive parents and guardian of person to be adoptive child write together on section of declarer. No. ⑧ : Please write name and resident register No. of submitter(Regardless of the declarer is true or not) [접수담당공무원은 신분증과 대조]
Attached documents
※ Please can omit to attach below No.1 if the data is checked by computer processing. 1. Each one set of basic certificate, family relation certificate and adoption relative certificate of family relation register for adoptive person. 2. One set of agreement of adoption(In case of requirement of agreement of adoption, but except to agreement person wrote name and resident register No. on section of "assentient" and sealed and signatured). 3. Permission copy of family court about agreement of adoption or permission of adoption (In case person to be adoptive child is minor and he hasn't parents or the other lineal ascendant so in case he must receive the agreement of guardian, in case the guardian adopt a ward as adoptive chid and if the guardian approve the adoption). 4. If adoptive parents are foreigner, attach the certificate for nationality(Ex.: Copy of family register, certificate of birth, copy of pass port, copy of identification register and etc.) 5. If adoptive child is foreigner, if the law of the domicile for the child require permission or agreement of child or the third party for establishing the relevant identification act, attach the written for certificating that requirement is satisfy. 6. Identification [In accordance with Article. 23 of the family relation register established rule] - In case of declarer's attendance : Certificate of identification for all declarer - In case of declarer's nonappearance, submitter's attendance : Submitter's identification and certificate of identification for all declarer or the written notarization or certificate of seal impression.(If declarer signed on report without certificate of identification, attach signature notarization and if declarer sealed on report without certificate of identification, attach the certificate of seal impression) - In case of postal submission : Signature notarization or seal impression certificate for all declarer (If signed on report, attach signature notarization and if sealed on report, attach certificate of seal impression) ※ If adoptive child is under 15 years old, in case of attendance of legal representative or submission of identification or attachment of seal impression certificate are same case of submission of identification certificate of declarer or attachment of seal impression certificate.

[

Report of adoption

[입양신고서]

* Writing method(작성방법) :

- If real biological parents, adoptive parents or adopted child are foreigner, please write the nationality on section of the permanent domicile address.

- 친생부모, 양친 또는 양자가 외국인인 경우에는 그 등록기준지란에 국적을 기재합니다.

① Adoptive parents (adoptive father / adoptive mother) 양친 (양부/양모)

* Writing method (No. 1and 2) ( 작성방법 1번 ~ 2번) :

- If you wrote the resident register No. on section of the resident registration No.,

can omit to write the date of birth in accordance with Article 25 Section 2 of the

Law.

- 법 제25조제2항에 따라 주민등록번호란에 주민등록번호를 기재한 때에는 출생연월일의

기재를 생략할 수 있습니다.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s name in Korean or English and in Chinese characters.

양친(양부/양모)의 성명을 한글과 한자로 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s place of family

origin in Chinese characters. 양친(양부/양모)의 본을 한자로 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s date of birth

(day/month/year). 양친(양부/양모)의 출생연월일을 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s resident

registration No. 양친(양부/양모)의 주민등록번호를 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s permanent

domicile address and address. 양친(양부/양모)의 등록기준지와 주소를 쓰세요.

② Adopted child (양자)

￭ Please write the adopted child's name in Korean or English and in Chinese

characters. 양자의 성명을 한글과 한자로 쓰세요.

￭ Please write the adopted child's place of family origin in Chinese characters.

양자의 본을 한자로 쓰세요.

￭ Please write the adopted child's resident registration No.

양자의 주민등록번호를 쓰세요.

￭ Please check on sex of adopted child 1)Male 2)Female.

양자의 성별에 체크하세요 1)남자 2)여자.

￭ Please write the adopted child's date of birth(day/month/year).

양자의 출생연월일을 쓰세요.

￭ Please write the adopted child's permanent domicile address and address.

양자의 등록기준지와 주소를 쓰세요.

③ Real biological parents of adopted child(father/mother)

양자의 친생부모(부/모)

￭ Please write real biological parents(father/mother)'s name.

(친생부모(부/모)의 성명을 쓰세요)

￭ Please write real biological parents(father/mother)'s permanent domicile address.

(친생부모(부/모)의 등록기준지를 쓰세요)

￭ Please write real biological parents(father/mother)'s resident registration No.

(친생부모(부/모)의 주민등록번호를 쓰세요)

4. Other (기타)

* Writing method (작성방법) :

- Please write below items and especially necessary informations for clarifying the

family relation register.

- 아래의 사항 및 가족관계등록부에 기록을 분명하게 하는데 특히 필요한 사항을 기재

합니다

- If legal representative of adopted child(Less than full fifteen years old) or guardian

who is approved by family court permitted the adoption and reported in place of

him, please write the reason.

- 양자가 될 자(만 15세 미만)의 법정대리인 또는 가정법원의 허가를 받은 후견인이 그를

갈음하여 입양을 승낙하고 이를 신고하는 때에는 그 사유

- In accordance with Article 8. section 1.「Exemption law for promotion and

procedure of adoption」if surname and place of family origin of adopted child

follow as surname and place of family origin of adoptive parents by demand of

adoptive parents, please write about that.

-「입양촉진 및 절차에 관한 특례법」제8조제1항에 따라 양자의 성과 본을 양친의 원에

의하여 양친의 성과 본을 따르는 경우에는 그에 관한 사항

⑤ Witness(증인)

￭ Please write name with seal and signature of witness.

(증인의 성명을 쓰고 기명날인 하세요)

￭ Please write resident registration No. and address of witness.

(증인의 주민등록번호와 주소를 쓰세요)

⑥ Assentient(동의자)

* Writing method (작성방법) :

- The person who will be adopted, must receive the agreement from parents (but, if

the parents was registered on family relation register who was lost by judgment the

parental authority about him, the parents can't agree), if the parents can't agree by

death or other reasons, must receive from the nearest and the eldest ascendant of

the other lineal ascendant.

- 양자가 될 자는 부․모의 동의를 받아야 하며(다만, 가족관계등록부에 판결에 의하여

친권이 상실된 자로 기록된 부 또는 모는 동의할 수 없습니다), 부․모가 사망 그 밖의

사유로 인하여 동의를 할 수 없는 경우에 다른 직계존속이 있으면 직계존속 중 제일

가까운 존속․ 중 연장자의 순으로 동의를 받아야 합니다.

￭ Please write name with seal and signature of parents(father/mother).

(부모의 성명을 쓰고 기명날인 하세요)

￭ Please write name with seal and signature of lineal ascendant.

(직계존속의 성명을 쓰고 기명날인 하세요)

￭ Please write resident registration No. of lineal ascendant.

(직계존속의 주민등록번호를 쓰세요)

￭ Please write relation with lineal ascendant and adopted child.

(직계존속과 양자와의 관계를 쓰세요)

* Writing method (작성방법) :

- If person who has a spouse is to be adopted child, must receive the agreement

from the other person.

- 배우자 있는 자가 양자가 될 때에는 다른 한쪽의 동의를 받아야 합니다.

￭ Please write name with seal and signature of spouse.

(배우자의 성명을 쓰고 기명날인 하세요)

￭ Please write resident registration No. of spouse.

(배우자의 주민등록번호를 쓰세요)

* Writing method (작성방법) :

-  The person who will be adopted, if he is minor and if he hasn't anyone of above

mentioned parents or lineal ascendant, must receive the agreement from the

guardian who is permitted by family court.

- 양자가 될 자가 미성년자이고, 그 미성년자에 대하여 위에서 언급한 부․모나 직계존속

이 없는 경우에는 가정법원의 허가를 받은 후견인의 동의가 있어야 합니다.

- Instead approval person of adoption don't have to write on section of assentient.

- 입양대락자는 입양동의자란에 기재하지 않아도 됩니다.

- When an incompetent adopt or is adopted, must receive the agreement from

guardian.

- 금치산자가 양자를 입양시키거나 양자가 되고자 할 때에는 후견인의 동의를 받아야 합

니다.

￭ Please write name with seal and signature of guardian.

(후견인의 성명을 쓰고 기명날인 하세요)

￭ Please write resident registration No. of guardian.

(후견인의 주민등록번호를 쓰세요)

￭ Please write name of permission court. (허가법원의 이름을 쓰세요)

￭ Please write date of permission. (허가일자를 쓰세요)

⑦ Declarer (신고인)

￭ Please write name with seal and signature of adoptive father and mother.

(양부와 양모의 성명을 쓰고 기명날인 하세요)

￭ Please write tel No. and e-mail address of adoptive father and mother.

(양부와 양모의 전화번호와 이메일주소를 쓰세요)

* Writing method (작성방법) :

- Person to be adopted seal and signature(or sign) on section of adopted child, but

if he is under 15 years old, don't write on section of adopted child and legal

representative(the guardian who is permitted by family court, write name of

permission court and permission date) seal and signature(or sign) after marking as

“○” on relevant item number .

- 양자란에는 양자가 될 자가 기명날인(또는 서명)하며, 다만 양자가 될 자가 15세 미만

인 때에는 양자란에는 기재하지 않고 법정대리인(가정법원의 허가를 받은 후견인은 허

가법원과 허가일자를 기재)이 법정대리인란의 해당 항목번호에 “○” 으로 표시한 후 기

명날인(또는 서명)합니다.

- If you repot the adoption in accordance with 「Exemption law for promotion and

procedure of adoption」, person to be adoptive parents and guardian of person to

be adoptive child write together on section of declarer.

- 입양촉진 및 절차에 관한 특례법에 의한 입양신고의 경우에는 양친될 자와 양자 될 자

의 후견인이 함께 신고인란에 기재합니다.

￭ Please write name with seal and signature of adopted child.

(양자의 성명을 쓰고 기명날인 하세요)

￭ Please write tel No. and e-mail address of adopted child.

(양자의 전화번호와 이메일주소를 쓰세요)

Legal representative(법정대리인)

￭ Please write name with seal and signature of parents(father/mother).

(부모의 성명을 쓰고 기명날인 하세요)

￭ Please write tel No. and e-mail address of parents(father/mother).

(부모의 전화번호와 이메일주소를 쓰세요)

￭ Please write name with seal and signature of guardian.

(후견인의 성명을 쓰고 기명날인 하세요)

￭ Please write tel No. and e-mail address of guardian.

(부모의 전화번호와 이메일주소를 쓰세요)

In case of permission for adoption under 15 years old

(15세미만자의 입양승락의 경우)

￭ Please write name of permission court. (허가법원의 이름을 쓰세요.)

￭ Please write date of permission. (허가날짜를 쓰세요.)

⑧ Submitter(제출자)

* Writing method (작성방법) :

- Please write name and resident registration No. of submitter

(Regardless of declarer)

- 제출자(신고인 여부 불문)의 성명 및 주민등록번호 기재

￭ Please write name and resident registration No. of submitter.

(제출자의 성명과 주민등록번호를 쓰세요.)

Attached documents 첨부서류

※ Please can omit to attach below No.1 if the data is checked by computer processing.

아래 1항은 전산정보처리조직에  의하여 그 내용을 확인할 수 있는 경우에는 첨부를 생략할 수 있습니다

1. Each one set of basic certificate, family relation certificate and adoption relative certificate of family relation register for adoptive person

입양당사자의 가족관계등록부의 기본증명서, 가족관계증명서 및 입양관계증명서각 1통

2. One set of agreement of adoption(In case of requirement of agreement of adoption, but except to agreement person wrote name and resident register No. on section of "assentient" and sealed and signatured)

입양동의서1부(입양에 대한 동의가 필요한 경우, 다만 동의한 사람이 입양신고서의 “동의자”란에 성명과 주민등록번호를 기재하고 기명날인 한 때에는 제외)

3. One set permission copy of family court about agreement of adoption or permission of adoption (In case person to be adoptive child is minor and he hasn't parents or the other lineal ascendant so in case he must receive the agreement of guardian, in case the guardian adopt a ward as adoptive chid and if the guardian approve the adoption)

입양동의 또는 입양승낙에 대한 가정법원의 허가서 등본 1부(양자가 될 자가 미성년자로서 부모 또는 다른 직계존속이 없어 후견인의 동의를 받아야 하는 경우, 후견인이 피후견인을 양자로 하는 경우 및 후견인이 입양승낙을 하는 경우)

4. If adoptive parents are foreigner, attach the certificate for nationality (Ex.: Copy of family register, certificate of birth, copy of pass port, copy of identification register and etc)

양친이 외국인인 경우 그 국적을 증명하는 서면(예: 호적등본, 출생증명서, 여권사본, 신분등록부등본 등)

5. If adoptive child is foreigner, if the law of the domicile for the child require permission or agreement of child or the third party for establishing the relevant identification act, attach the written for certificating that requirement is satisfy

양자가 외국인인 경우, 그 자녀의 본국법이 해당 신분행위의 성립에 자녀 또는 제3자의 승낙이나 동의 등을 요건으로 하는 경우에는 그 요건을 갖추었음을 증명하는 서면

6. Identification

[In accordance with Article 23 of the family relation register established rule]

신분확인[가족관계등록예규 제23호에 의함]

- In case of declarer's attendance : Certificate of identification for all declarer

- 신고인이 출석한 경우 : 신고인 모두의 신분증명서

- In case of declarer's nonappearance, submitter's attendance : Submitter's

identification and certificate of identification for all declarer or the written

notarization or certificate of seal impression.(If declarer signed on report without

certificate of identification, attach signature notarization and if declarer sealed on

report without certificate of identification, attach the certificate of seal impression)

- 신고인 불출석, 제출인 출석의 경우 : 제출인의 신분증명서 및 신고인 모두의 신분증명

서 또는 서면공증 또는 인감증명서(신고인의 신분증명서 없이 신고서에 신고인이 서명

한 경우 서명공증, 신고서에 인감 날인한 경우는 인감증명)

- In case of postal submission : Signature notarization or seal impression certificate for

all declarer (If signed on report, attach signature notarization and if sealed on

report, attach certificate of seal impression)

- 우편제출의 경우 : 신고인 모두의 서명공증 또는 인감증명서(신고서에 서명한 경우 서

명공증, 인감을 날인한 경우는 인감증명서)

※ If adoptive child is under 15 years old, in case of attendance of legal

representative or submission of identification or attachment of seal impression

certificate are same case of submission of identification certificate of declarer or

attachment of seal impression certificate.

양자가 15세 미만인 입양에 있어서 법정대리인의 출석 또는 신분증명서의 제시가 있거나 인감증명서의 첨부가 있으면 신고인의 신분증명서 제시 또는 인감증명서의 첨부가 있는 것으로 볼 수 있습니다.